Exploring the impact of extraocular disorders and their surgical correction on corneal astigmatism and higher-order aberrations: a comprehensive review.

Extraocular disorders and their surgical management can significantly influence corneal astigmatism and higher-order aberrations (HOAs). This review aimed to evaluate the relationship between extraocular conditions, their surgical correction, and subsequent changes in corneal astigmatism and HOAs. A comprehensive literature search was conducted using PubMed, Scopus, and Web of Science, including studies published between 1992 and 2024. Search terms included astigmatism, eyelid surgery, thyroid eye disease (TED), orbital decompression, blepharoplasty, chalazion, dermatochalasis, ptosis, pterygium, scleral buckle, and HOAs. The reviewed literature demonstrates that a wide spectrum of extraocular disorders (such as ptosis, dermatochalasis, TED, chalazion, and pterygium) are associated with clinically significant changes in corneal astigmatism and HOAs. These alterations are affected by factors including lesion size, anatomical location, and the type of surgical intervention. For instance, ptosis surgery may either reduce or induce astigmatism depending on patient age and surgical technique, while chalazion excision and pterygium removal frequently lead to meaningful reductions in astigmatism and HOAs, particularly in cases involving larger lesions. The timing of postoperative evaluation and surgical approach plays a critical role in the magnitude and persistence of these optical changes. Awareness of the impact of extraocular diseases and their surgical treatment on corneal astigmatism and HOAs is essential for accurate interpretation of refractive changes, postoperative follow-up, and optimal patient management.